STATE OF LOUISIANA
OFFICE OF FINANCIAL INSTITUTIONS
Baton Rouge, Louisiana
REPOSSESSION AGENT/APPRENTICE APPLICATION INSTRUCTIONS
A Repossession Agent Application must be submitted for each person who meets the definition of a Repossession
Agent.
LAC 10:XV.1301 defines Repossession Agent as follows: "an individual who physically obtains possession of
collateral for a secured party and engages in business or accepts employment to locate or recover collateral registered
under the provisions of the Louisiana Vehicle Certificate of Title Law, R.S. 32:701 et seq, which has been sold under a
security agreement or used as security in a loan transaction. Included in this definition are secured creditors’
employees who repossess collateral pursuant to the “Additional Default Remedies Act.”
LAC 10:XV.1303.E.3 states” “No repossession agency shall sponsor more than one apprentice for every two licensed
repossession agents at any one time.”
ATTACHMENTS:
FEES:
$400 application fee (Regular Agents and Apprentices only.)
$39.25 background processing fee
APPLICATION:
Complete application signed by an authorized company representative and notarized
BACKGROUND INFORMATION INCLUDING:
AUTHORITY TO OBTAIN INFORMATION FROM OUTSIDE SOURCES FORM:
This form must be completed and signed by each Repossession Agent/apprentice applicant
and notarized. Information contained in this document is kept confidential.
FINGERPRINT CARDS: Include 2 non-duplicated cards
LOUISIANA STATE POLICE CRIMINAL IDENTIFICATION AND INFORMATION FORM:
Louisiana State Police will not process incomplete forms. Incomplete forms will be returned. (Form
included with application.)
PROOF OF EMPLOYMENT:
Submit evidence of two years experience as a repossession agent or apprentice within the previous three years as
per LAC 10:XV. 1303(D)(d). Each year of experience shall consist of at least 1,000 hours of actual compensated
work performed by the applicant with a repossession agency preceding the filing of an application. An applicant
shall substantiate the claimed hours of experience by providing IRS forms, W-2’s, and/or 1099’s and the exact
details as to the character and nature of duties by written certifications from the employer as per LAC 10:XV.
1303(F). (Sample letter included with application.)
PROOF OF BEING A CERTIFIED RECOVERY SPECIALIST:
Submit proof of designation as a certified recovery specialist from a recognized national certification program as
per LAC 10:XV.1303(C)(1)(f). (Listed on last page of application).
COPY OF DRIVER’S LICENSE:
Submit a clear, legible copy of your current driver’s license. This number will appear on your ID card. The
address should match the address listed on Attachment D.
For questions regarding this application please contact the Non-Depository Division Licensing Department:
225-925-4660 or ofilicensing@ofi.la.gov or Fax: (225) 922-2860.
REPOSSESSION AGENT/APPRENTICE APPLICATION
1. Complete Name of Applicant:
Phone Number: Business ( ) Fax ( )
Cell ( ) E-Mail address: ______________________________
2. (a) Name of Employer :
(b) Municipal Address of Main Office:
3. Submit your work experience and residential address. (See attachments C and D)
4. Type of License:
Qualifying Agent (Do not submit separate fee)
Repossession Agent
Apprentice
EMPLOYER CERTIFICATION
(Must be completed by the authorized employer representative)
I hereby affirm or attest that (Agent Name)
is a/an owner W-2 employee of (Company Name) and
will be acting on the company’s behalf as a Repossession Agent/Apprentice. I also affirm that he/she ONLY engages in
repossession activities for this company. I further affirm that he/she is covered under the company’s surety bond.
Signed this day of , 20 .
(Signature of authorized Company Representative) (Print Name and Title)
* * * * * * * * * * * * * * * * * * * * * *
STATE OF
PARISH OR COUNTY OF
Before me, the undersigned authority, personally came and appeared (Name)
who, first being duly sworn, declared under oath that he/she is the (Title) of
(Company Name) and that all statements and representations made in the
foregoing registration are true and correct to the best of his/her knowledge and belief.
Sworn to and subscribed before me on this day of , 20 ,
at , .
(City) (State)
(Signature of Notary Public) (Print name of Notary Public)
Affix Seal
Attachment B
CONFIDENTIAL
AUTHORITY TO OBTAIN INFORMATION FROM OUTSIDE SOURCES
Name:
Social Security #:
Drivers License #:
(Attach legible copies)
Home Address, City, State, Zip Code:
Date of Birth:
Home Telephone No:
Read the following questions carefully. If the answer is “yes” to any of the questions, attach a full written explanation.
Include names, dates, court name and address, case number, judgment amounts.
Have you ever been convicted of, pleaded guilty to, or entered a plea of Nolo
Contendere (no contest) to a felony, including any which may have been
expunged, set aside or for which you received a first offense pardon?
( ) Yes, attach explanation ( ) No
Have you ever been convicted of, pleaded guilty to, or entered a plea of Nolo
Contendere (no contest) to any misdemeanor involving theft, fraud, or dishonesty
, including any which may have been expunged, set aside or for which you
received a first offense pardon?
( ) Yes, attach explanation ( ) No
Have you ever been refused a license or permit to do business under the
provisions of a similar law or subject to any enforcement proceedings by any
State or Federal government agency involving the revocation or suspension of any
business license or permit, fines or penalties?
( ) Yes, attach explanation ( ) No
Have you been discharged for cause or been requested to resign from any
employment position?
( ) Yes, attach explanation ( ) No
Have you been the subject of a bankruptcy, assignment for the benefit of
creditors, receivership, conservatorship, or any similar proceeding?
( ) Yes, attach explanation ( ) No
Are there any civil proceedings pending against you or civil judgments entered
against you which involve fraud or dishonesty?
( ) Yes, attach explanation ( ) No
Have any civil judgments been entered against you during the past 10 years?
( )Yes, attach explanation ( ) No
PRINT NAME OF NOTARY PUBLIC:
SIGNATURE OF NOTARY PUBLIC:
Louisiana State Police
Bureau of Criminal Identification and Information
Baton Rouge, Louisiana
**FORMS MUST BE FILLED OUT IN INK AND BE REVIEWED BY SUBMITTING AGENCY/INDIVIDUAL FOR ACCURACY**
****FINGERPRINTS ARE NECESSARY FOR A POSITIVE IDENTIFICATION****
_____________________________________________________________________________________________________________________________________________________________________________________
****PLEASE PRINT****
Louisiana Office of Financial Institutions Michelle Jeansonne
FACILITY OR AGENCY FACILITY OR AGENCY AUTHORIZED REPRESENTATIVE
P.O. Box 94095
MAILING ADDRESS SIGNATURE OF AUTHORIZED REPRESENTATIVE
Baton Rouge, Louisiana 70804 (225) 925-4660
CITY STATE ZIP CODE FACILITY OR AGENCY PHONE NUMBER
Request For: (pick one only)
□ ADULT DAY CARE
□ ADULT RESIDENTIAL
□ ALCOHOL AND BEVERAGE COMMISSION
□ ALCOHOL BEVERAGE OUTLET
□ AMBULANCE SERVICE
□ CASA
□ CONCEALED HANDGUNS
□ CRIMINAL JUSTICE EMPLOYEE
□ DAYCARE
□ DENTISTRY BOARD
□ DEPARTMENT OF LABOR
□ DEPARTMENT OF PUBLIC SAFETY
□ EMPLOYERS
□ FIREFIGHTERS
□ GAMING
□ HOME HEALTH AGENCY
□ HOSPICE
□ IMMIGRATION
□ INTERMEDIATE CARE FACILITY FOR
MENTALLY RETARDED
□ JUVENILE DETENTION CENTER
□ DEPARTMENT OF INSURANCE
□ MANUFACTURED HOUSING
□ MEDICAL EXAMINERS
□ NURSING HOME
□ OCS FOSTER/ADOPTIVE
□ OCS PERSONNEL
OFFICE OF FINANCIAL INSTITUTIONS
□ OFFICE OF PUBLIC HEALTH
□ PHARMACY BOARD
□ POSTSECONDARY EDUCATION
□ PRACTICAL NURSING
□ PRIVATE ADOPTION
□ PRIVATE INVESTIGATORS
□ PRIVATE SECURITY
□ PUBLIC HOUSING
□ PUBLIC TAG AGENT
□ REGISTERED NURSING
□ RELIGIOUS ACTIVISTS
□ RIVERBOAT PILOTS
□ SCHOOL
□ SENATE AND GOVERNMENTAL AFFAIRS
□ TAXI DRIVERS
□ USED MOTOR VEHICLE COMMISSION
□ VOLUNTEERS WORKING WITH CHILDREN
APPLICANTS FULL NAME: ___________________________________________________________________________
****PRINT – USE INK**** LAST FIRST MIDDLE
{INCLUDE MAIDEN NAME & PREVIOUS MARRIED NAMES IF APPLICABLE}
APPLICANTS SIGNATURE: ___________________________________________________________________________
APPLICANTS SOCIAL SECURITY # _ _ _ - _ _ - _ _ _ _ DATE OF BIRTH: _ _ / _ _ / _ _
DRIVERS LICENSE #____________________& STATE ______ RACE ____ SEX ____
TYPE OF OFI LICENSE APPLIED FOR ________________________
AUTHORIZATION TO DISCLOSE CRIMINAL HISTORY RECORDS INFORMATION
By my signature above, I hereby authorize the Louisiana State Police to release all pertinent criminal record information
maintained in their files, other states files, or the FBI files (if applicable ) which may confirm or deny my eligibility with the
facility or agency named above.
Attachment C
NAME: ____________________________________________
COMPANY: ________________________________________
EMPLOYMENT/EXPERIENCE HISTORY FOR THE LAST 10 YEARS
Each sole proprietor, officer, director, partner, member, manager and 10% or greater equity owner of applicant must fill out this
form. You may submit your own resume' as long as it includes the information listed below. Include Month and Year. Include a
complete 10 years. Explain any gaps in work history.
(Attach additional sheets, if necessary).
Employer Name and Address
Position/Brief
Description of
Duties
Start Date
End Date
Reason for Leaving
Attachment D
NAME: ____________________________________________
COMPANY: ________________________________________
RESIDENTIAL ADDRESSES FOR THE LAST 10 YRS
Each sole proprietor, officer, director, partner, member, manager and each 10% or greater equity owner of
applicant must fill out this form. Include Month and Year. Include a complete 10 years. Explain any gaps in residential
history. (Attach additional sheets, if necessary)
Residential Address
Start Date
End Date
LOUISIANA OFFICE OF FINANCIAL INSTITUTIONS
8660 United Plaza Boulevard, 2
nd
Floor
Baton Rouge, LA 70809
(225) 925-4660
FINGERPRINT CARD INFORMATION
Act 236 of the 2006 Regular Session of the Louisiana Legislature amended LSA-R.S. 6:121.2 effective June 2, 2006. This section
authorizes the Commissioner of Financial Institutions to request and obtain state and national criminal history record information
on any person applying for any license with the Office of Financial Institutions, as well as require any applicant for any license to
submit two full sets of fingerprints in a form or manner prescribed by the Commissioner as a condition of the Commissioner’s
consideration of their application.
WHO MUST SUBMIT FINGERPRINT CARDS:
1) Owner(s): Sole Proprietors; partners and general partners, if partnership;
trustees; members and general members, if an LLC; and 10% or greater equity owners.
2) Director(s): All directors.
3) Officer(s): Chief Executive Officer, Chief Operating Officer, Chief Financial
Officer, President, Executive Vice President(s), Corporate
Secretary, Treasurer, or individuals of similar status or function.
4) Repossession Agent(s)
WHAT MUST BE SUBMITTED:
1) Two original Form FD 258 fingerprint cards or equivalent which can be obtained from your local law
enforcement office. In addition to your fingerprints, the cards must have your Social Security Number, date of
birth, printed name, and signature. If submitting cards done electronically (digital cards) the fingerprints on
each card should be taken separately instead of taken once and printed out twice. A duplicated card that gets
rejected may result in an additional $39.25 processing fee and will delay the processing of application.
2) $39.25 per person nonrefundable criminal background processing fee made payable to the
Office of Financial Institutions. (This fee is in addition to the application fee.)
3) Completed Authority to Obtain Information from Outside Sources form, signed and dated and notarized
(included in application packet).
4) Completed and signed Louisiana State Bureau of Criminal Identification and Information Form (included in
application packet).
IMPORTANT NOTICE
Applicants submitting fingerprint cards that are smudged or unreadable will be required to
resubmit new cards. This will add to the processing time of the application.
Fingerprints & Background Reports “FAQ”
•What is OFI’s authority to require fingerprints and a FBI background check?
LSA-R.S. 6:121.2(B) states “The commissioner shall have the authority to:
(1) Request and obtain state and national criminal history record information on any person applying for any
license with the Office of Financial Institutions.
(2) Require any applicant for any license to submit two full sets of fingerprints, in a form and manner
prescribed by the commissioner, as a condition of the commissioner’s consideration of his application…”
• What is my fingerprint card used for?
The fingerprints will be used to check the criminal records of the FBI and Louisiana State Police.
• What happens to my fingerprint cards submitted to OFI?
All fingerprint cards are shredded immediately upon receipt of the criminal history report.
• How is FBI information used?
The criminal history report received from the FBI is reviewed and considered as part of the overall character
and fitness evaluation of an individual associated with a licensee regulated by OFI. Identification records
obtained from the FBI may be used solely for the purpose requested and may not be disseminated outside OFI.
If information on the record is used to disqualify an applicant, the official making the determination of
suitability for licensing or employment shall provide the applicant the opportunity to complete or challenge
the accuracy of the information contained in the FBI identification record.
• How do I obtain a copy of, challenge or correct information in my FBI criminal history report?
If you wish to obtain a copy of your FBI criminal history report, challenge information contained therein,
correct or update the record as it appears in the FBI’s CJIS Division Records System, be advised that the
procedures are set forth in Title 28, CFR, Section 16.34 as cited below:
§ 16.34 Procedure to obtain change, correction or updating of identification records.
If, after reviewing his/her identification record, the subject thereof believes that it is incorrect or
incomplete in any respect and wishes changes, corrections or updating of the alleged deficiency, he/she
should make application directly to the agency which contributed the questioned information. The
subject of a record may also direct his/her challenge as to the accuracy or completeness of any entry on
his/her record to the FBI, Criminal Justice Information Services (CJIS) Division, ATTN: SCU, Mod.
D–2, 1000 Custer Hollow Road, Clarksburg, WV 26306. The FBI will then forward the challenge to
the agency which submitted the data requesting that agency to verify or correct the challenged entry.
Upon the receipt of an official communication directly from the agency which contributed the original
information, the FBI CJIS Division will make any changes necessary in accordance with the
information supplied by that agency.
“This is a sample letter for your convenience. You may insert appropriate names, dates, titles etc. in the [bracketed spaces below]
as necessary to accurately complete the letter. Delete these two sentences.”
[ Company letterhead ]
[ Address ]
[Date]
Office of Financial Institution
P.O. Box 94095
Baton Rouge, LA 70804-9095
RE: [insert agent’s name] - Work History
To the Non-Depository Licensing Section:
This letter is to inform you of [insert agent’s name] employment history with [insert company name.]
[Insert agent’s name] has been working as a repossession agent for [insert company name] since [insert date]. [Insert agent’s name]
has averaged 40-50 hours per week for each year [he or she] has worked, which consisted of over 1,000 compensated hours in each
of the following years, [2010, 2011 and 2012].
Therefore, I am requesting an approval of [his or her] Repossession Agent Application.
Best Regards,
[Signature of Authorized Person]
[Type name of authorized person]
[Authorized person’s title with the company]
[Company name]
Certified Recovery Specialist Designation
§1303. Licensing Requirements and Qualifications
D. Repossession Agent
1. To obtain a license as a repossession agent the applicant shall meet the following requirements:
e. have received a designation as a certified recovery specialist from a recognized national certification
program.
Any one of the following certification programs will be accepted.
1) 2 day workshop taught by Michael Howk through R.S.I.G. insurance - contact Michael Howk at 1-800-997-7224
for more information.
2 ) Certified Asset Recovery Specialist Certificate through R.I.S.C. (Matrix Educational system) (you call them, they
send you a book, you take the test online).
Call 1-866-996-7472 (Joe Taylor)
3) Certified Collateral Recovery Specialist through the Society of Certified Recovery Specialists (you call them,
they send a booklet and the test, you send back a check and the test) (you must have 3 years of experience in
order to take this test). Call them at 1-800-331-5518.